Question

A 45-year-old man is coming to the OPD with complaints of swelling in the right leg.
How will you diagnose DVT?

Hint:

Duplex ultrasound is the gold standard for diagnosing DVT. The D-dimer test can help rule out DVT in low-risk patients but is not specific enough for confirmation.

Answer 1

Step 1: Clinical Evaluation.
A thorough history and physical examination are essential. Clinical signs such as swelling, tenderness, and warmth in the affected leg, along with the patient's risk factors (e.g., recent surgery, immobility), should be considered. The Wells score can be used to assess the clinical probability of DVT.

Step 2: Imaging Tests.
- Duplex Ultrasound: This is the most commonly used imaging test for diagnosing DVT. It uses sound waves to create an image of the blood flow in the veins, helping to detect the presence of blood clots.
- Venography: Though less commonly used today due to the availability of ultrasound, venography involves injecting a contrast dye into the vein and taking X-ray images to detect clots.

Step 3: Laboratory Tests.
- D-dimer Test: Elevated levels of D-dimer, a breakdown product of fibrin, may indicate the presence of a clot. However, a negative D-dimer test can rule out DVT in low-risk patients, but a positive result requires further testing.